Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation

Javier Sanchez; Christopher Woods; Jason Zagrodzky; Jose Nazari; Matthew J. Singleton; Amir Schricker; Annie Ruppert; Babette Brumback; Benjamin Jenny; Charles Athill; Christopher Joseph; Dipak Shah; Gaurav Upadhyay; Erik Kulstad; John Cogan; Jordan Leyton-Mange; Julie Cooper; Kamala Tamirisa; Samuel Omotoye; Saroj Timilsina; Alejandro Perez-Verdia; Andrew Kaplan; Apoor Patel; Alex Ro; Andrew Corsello; Arun Kolli; Brian Greet; Danya Willms; David Burkland; Demetrio Castillo; Firas Zahwe; Hemal Nayak; James Daniels; John MacGregor; Matthew Sackett; W. Michael Kutayli; Michel Barakat; Robert Percell; Spyridon Akrivakis; Steven C. Hao; Taylor Liu; Ambrose Panico; Archana Ramireddy; Thomas Dewland; Edward P. Gerstenfeld; Daniel Benhayon Lanes; Edward Sze; Gregory Francisco; Jose Silva; Julia McHugh; Kai Sung; Leon Feldman; Nicholas Serafini; Raymond Kawasaki; Richard Hongo; Richard Kuk; Robert Hayward; Shirley Park; Andrew Vu; Christopher Henry; Shane Bailey; Steven Mickelsen; Taresh Taneja; Westby Fisher; Mark Metzl

doi:10.1016/j.jacep.2023.08.022

Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation

Javier Sanchez, Christopher Woods, Jason Zagrodzky, Jose Nazari, Matthew J. Singleton, Amir Schricker, Annie Ruppert, Babette Brumback, Benjamin Jenny, Charles Athill, Christopher Joseph, Dipak Shah, Gaurav Upadhyay, Erik Kulstad, John Cogan, Jordan Leyton-Mange, Julie Cooper, Kamala Tamirisa, Samuel Omotoye, Saroj TimilsinaAlejandro Perez-Verdia, Andrew Kaplan, Apoor Patel, Alex Ro, Andrew Corsello, Arun Kolli, Brian Greet, Danya Willms, David Burkland, Demetrio Castillo, Firas Zahwe, Hemal Nayak, James Daniels, John MacGregor, Matthew Sackett, W. Michael Kutayli, Michel Barakat, Robert Percell, Spyridon Akrivakis, Steven C. Hao, Taylor Liu, Ambrose Panico, Archana Ramireddy, Thomas Dewland, Edward P. Gerstenfeld, Daniel Benhayon Lanes, Edward Sze, Gregory Francisco, Jose Silva, Julia McHugh, Kai Sung, Leon Feldman, Nicholas Serafini, Raymond Kawasaki, Richard Hongo, Richard Kuk, Robert Hayward, Shirley Park, Andrew Vu, Christopher Henry, Shane Bailey, Steven Mickelsen, Taresh Taneja, Westby Fisher, Mark Metzl

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Background: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. Objectives: The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. Methods: This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. Results: A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001). Conclusions: Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.

Original language	English (US)
Pages (from-to)	2558-2570
Number of pages	13
Journal	JACC: Clinical Electrophysiology
Volume	9
Issue number	12
DOIs	https://doi.org/10.1016/j.jacep.2023.08.022
State	Published - Dec 2023

Keywords

atrial fibrillation
atrioesophageal fistula
esophageal cooling
radiofrequency ablation

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1016/j.jacep.2023.08.022

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Sanchez, J., Woods, C., Zagrodzky, J., Nazari, J., Singleton, M. J., Schricker, A., Ruppert, A., Brumback, B., Jenny, B., Athill, C., Joseph, C., Shah, D., Upadhyay, G., Kulstad, E., Cogan, J., Leyton-Mange, J., Cooper, J., Tamirisa, K., Omotoye, S., ... Metzl, M. (2023). Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation. JACC: Clinical Electrophysiology, 9(12), 2558-2570. https://doi.org/10.1016/j.jacep.2023.08.022

Sanchez, J, Woods, C, Zagrodzky, J, Nazari, J, Singleton, MJ, Schricker, A, Ruppert, A, Brumback, B, Jenny, B, Athill, C, Joseph, C, Shah, D, Upadhyay, G, Kulstad, E, Cogan, J, Leyton-Mange, J, Cooper, J, Tamirisa, K, Omotoye, S, Timilsina, S, Perez-Verdia, A, Kaplan, A, Patel, A, Ro, A, Corsello, A, Kolli, A, Greet, B, Willms, D, Burkland, D, Castillo, D, Zahwe, F, Nayak, H, Daniels, J, MacGregor, J, Sackett, M, Kutayli, WM, Barakat, M, Percell, R, Akrivakis, S, Hao, SC, Liu, T, Panico, A, Ramireddy, A, Dewland, T, Gerstenfeld, EP, Lanes, DB, Sze, E, Francisco, G, Silva, J, McHugh, J, Sung, K, Feldman, L, Serafini, N, Kawasaki, R, Hongo, R, Kuk, R, Hayward, R, Park, S, Vu, A, Henry, C, Bailey, S, Mickelsen, S, Taneja, T, Fisher, W & Metzl, M 2023, 'Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation', JACC: Clinical Electrophysiology, vol. 9, no. 12, pp. 2558-2570. https://doi.org/10.1016/j.jacep.2023.08.022

@article{add496a1621c4186bd4c1c3a3d5189d4,

title = "Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation",

abstract = "Background: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. Objectives: The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. Methods: This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. Results: A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001). Conclusions: Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.",

keywords = "atrial fibrillation, atrioesophageal fistula, esophageal cooling, radiofrequency ablation",

author = "Javier Sanchez and Christopher Woods and Jason Zagrodzky and Jose Nazari and Singleton, {Matthew J.} and Amir Schricker and Annie Ruppert and Babette Brumback and Benjamin Jenny and Charles Athill and Christopher Joseph and Dipak Shah and Gaurav Upadhyay and Erik Kulstad and John Cogan and Jordan Leyton-Mange and Julie Cooper and Kamala Tamirisa and Samuel Omotoye and Saroj Timilsina and Alejandro Perez-Verdia and Andrew Kaplan and Apoor Patel and Alex Ro and Andrew Corsello and Arun Kolli and Brian Greet and Danya Willms and David Burkland and Demetrio Castillo and Firas Zahwe and Hemal Nayak and James Daniels and John MacGregor and Matthew Sackett and Kutayli, {W. Michael} and Michel Barakat and Robert Percell and Spyridon Akrivakis and Hao, {Steven C.} and Taylor Liu and Ambrose Panico and Archana Ramireddy and Thomas Dewland and Gerstenfeld, {Edward P.} and Lanes, {Daniel Benhayon} and Edward Sze and Gregory Francisco and Jose Silva and Julia McHugh and Kai Sung and Leon Feldman and Nicholas Serafini and Raymond Kawasaki and Richard Hongo and Richard Kuk and Robert Hayward and Shirley Park and Andrew Vu and Christopher Henry and Shane Bailey and Steven Mickelsen and Taresh Taneja and Westby Fisher and Mark Metzl",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = dec,

doi = "10.1016/j.jacep.2023.08.022",

language = "English (US)",

volume = "9",

pages = "2558--2570",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier USA",

number = "12",

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TY - JOUR

T1 - Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation

AU - Sanchez, Javier

AU - Woods, Christopher

AU - Zagrodzky, Jason

AU - Nazari, Jose

AU - Singleton, Matthew J.

AU - Schricker, Amir

AU - Ruppert, Annie

AU - Brumback, Babette

AU - Jenny, Benjamin

AU - Athill, Charles

AU - Joseph, Christopher

AU - Shah, Dipak

AU - Upadhyay, Gaurav

AU - Kulstad, Erik

AU - Cogan, John

AU - Leyton-Mange, Jordan

AU - Cooper, Julie

AU - Tamirisa, Kamala

AU - Omotoye, Samuel

AU - Timilsina, Saroj

AU - Perez-Verdia, Alejandro

AU - Kaplan, Andrew

AU - Patel, Apoor

AU - Ro, Alex

AU - Corsello, Andrew

AU - Kolli, Arun

AU - Greet, Brian

AU - Willms, Danya

AU - Burkland, David

AU - Castillo, Demetrio

AU - Zahwe, Firas

AU - Nayak, Hemal

AU - Daniels, James

AU - MacGregor, John

AU - Sackett, Matthew

AU - Kutayli, W. Michael

AU - Barakat, Michel

AU - Percell, Robert

AU - Akrivakis, Spyridon

AU - Hao, Steven C.

AU - Liu, Taylor

AU - Panico, Ambrose

AU - Ramireddy, Archana

AU - Dewland, Thomas

AU - Gerstenfeld, Edward P.

AU - Lanes, Daniel Benhayon

AU - Sze, Edward

AU - Francisco, Gregory

AU - Silva, Jose

AU - McHugh, Julia

AU - Sung, Kai

AU - Feldman, Leon

AU - Serafini, Nicholas

AU - Kawasaki, Raymond

AU - Hongo, Richard

AU - Kuk, Richard

AU - Hayward, Robert

AU - Park, Shirley

AU - Vu, Andrew

AU - Henry, Christopher

AU - Bailey, Shane

AU - Mickelsen, Steven

AU - Taneja, Taresh

AU - Fisher, Westby

AU - Metzl, Mark

PY - 2023/12

Y1 - 2023/12

N2 - Background: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. Objectives: The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. Methods: This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. Results: A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001). Conclusions: Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.

AB - Background: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. Objectives: The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. Methods: This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. Results: A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001). Conclusions: Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.

KW - atrial fibrillation

KW - atrioesophageal fistula

KW - esophageal cooling

KW - radiofrequency ablation

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U2 - 10.1016/j.jacep.2023.08.022

DO - 10.1016/j.jacep.2023.08.022

M3 - Article

C2 - 37737773

AN - SCOPUS:85173176797

SN - 2405-500X

VL - 9

SP - 2558

EP - 2570

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

IS - 12

ER -

Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation

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